SCREAM stands for the ”Stockholm CREAtinine Measurements" project and has the principal aims to estimate the burden and consequences of chronic kidney disease (CKD) in healthcare, and to identify inappropriate drug use (prescription of nephrotoxic, contraindicated or ill-dosed drugs).


The development of simple creatinine-based equations to estimate kidney function has contributed to raise awareness on the epidemics of chronic kidney disease (CKD) to the category of major public health problem. CKD is an important contributor to the burden of non-communicable diseases, leading to poor quality of life and severely reduced life expectancy. CKD also has a substantial impact on societal costs, by increasing per se the need for healthcare services and contributing to work disability. Further, the consequences of CKD are of importance for many other aspects of healthcare, including the incidence of other comorbidities or impairment on the diagnostic accuracy of laboratorial analyses and medical devices dependent on protein or fluid retention by the failing kidneys. Notwithstanding that creatinine is a very common and low-cost assessment in healthcare, systematic screening programs are lacking and, in most societies, the awareness of CKD among both physicians and patients remains very low.

Kidney dysfunction affects, and also is affected by drug metabolism. Many drugs have nephrotoxic effects per se or by forcing hydrophilic drug hyperfiltration in damaged kidneys. Further, significant morbidity is experienced due to medication accumulation and exposure in CKD, commonly leading to adverse events, prolonged length of hospital stay, increased healthcare cost and even death, even when drug clearance is mediated by non-renal mechanisms. Due to low CKD awareness, the risk for inappropriate drug utilization in the community is high, compromising drug safety and effectiveness.

Project description

SCREAM is a complete healthcare utilisation cohort of Stockholm residents. SCREAM has been made possible by collaboration with our healthcare provider, Region Stockholm (formerly Stockholm County Council), and its main laboratory service providers (Unilabs, Karolinska and Aleris), which together perform the vast majority of laboratory analyses of the County.

Map of the healthcare use in Region Stockholm for routine creatinine testing.

SCREAM includes laboratory and healthcare use information of all residents of the region of Stockholm that underwent plasma creatinine or albuminuria testing in connection to a healthcare consultation.

  • The first phase (period 2006-2012) includes 1.3 million adults (68% of the population census for that period).
  • The second phase (period 2006-2019) is currently under construction.

Together with kidney function estimates, a wide range of laboratory measurements is also available. Laboratory data was thereafter linked with a variety of Regional and National Health Care Registers to conform the largest and most comprehensive healthcare utilisation cohort of Sweden.

SCREAM is coupled with a practical implementation program within Region Stockholm aimed at raising awareness among prescribers of the importance of kidney dysfunction and drug interactions.

We welcome research collaborations. Please, do contact us if you share our fascination for cardiorenal epidemiology research.

Overview of register linkages and data sources of the SCREAM study 2006-2019.
Profile image

Juan-Jesus Carrero

Project leader, Professor

Jim Alkas, PhD student

Edouard L Fu, PhD student, LUMC, the Netherlands

Michael Eklund, PhD student, Örebro Universitet

Nanbo Zhu, PhD student, KI

Yang Xu, Postdoctoral researcher, KI

Guobin Su, Postdoctoral researcher, KI

Hong Xu, Postdoctoral researcher, KI

Alessandro Gasparini, Postdoctoral researcher, KI

Erik Nilsson, Postdoc, Örebro Universitet

Junichi Ishigami, Assistant Scientist, John Hopkins Bloomberg School of Public Health

Zheng Chang, assistant professor, KI

Vivekananda Lanka, Database manager

Linn Austin, Research administrator

Peter Barany, MD and Associate Professor, KI/KS

Arvid Sjölander, Senior researcher, KI

Gianluigi Savarese, Senior researcher, Assistant Professor, Associate Professor, KI

Marie Evans, MD, PhD, KI/KS

Karolina Szummer, MD, KI/KS

Abdul R. Qureshi, Senior researcher, KI

Fang Fang, professor, KI

Carl G. Elinder, Professor, MD, KI/KS

Bengt Lindholm, Adjunct Professor, Baxter Novum, KI

Paul Hjemdal, Senior Professor, KI

Tomas Jernberg, Professor/Senior physician, KI

Lars H Lund, Professor/Senior physician, KI

Johan Ärnlöv, Professor, KI

Rino Bellocco, Professor, University of Milano-Bicocca/Senior Lecturer, KI

Björn Wettermark, Professor, Uppsala Universitet

Friedo W Dekker, Professor, LUMC, the Netherlands

CKD-prognosis consortium, International

Global Burden of disease consortium, International


Our work has received funding from several public funding bodies, including The Swedish Research Council (VR), The Swedish Heart and Lung Foundation (HLF), Stockholm County Council (ALF), the Stig and Gunborg Westman Foundation, the Martin Rind's Foundation, the European Renal Association – European Dialysis and Transplantation Association (ERA-EDTA) and the US National Institutes of Health (NIH). Our post-marketing surveillance of kidney disease and cardiovascular therapies has received funding from AstraZeneca, ViforPharma, Astellas, Merck, and Novartis.


Bisphosphonate utilization across the spectrum of eGFR.
Titan SM, Laureati P, Sang Y, Chang AR, Evans M, Trevisan M, et al
Arch Osteoporos 2020 May;15(1):69

Association between reduced kidney function and incident hypoglycaemia in people with diabetes: The Stockholm Creatinine Measurements (SCREAM) project.
Runesson B, Xu Y, Qureshi AR, Lindholm B, Barany P, Elinder CG, et al
Diabetes Obes Metab 2020 Apr;():

Estimated Glomerular Filtration Rate and the Risk of Cancer.
Xu H, Matsushita K, Su G, Trevisan M, Ärnlöv J, Barany P, et al
Clin J Am Soc Nephrol 2019 04;14(4):530-539

Kidney Dysfunction and the Risk of Developing Aortic Stenosis.
Vavilis G, Bäck M, Occhino G, Trevisan M, Bellocco R, Evans M, et al
J. Am. Coll. Cardiol. 2019 01;73(3):305-314

Prevalence of renally inappropriate medicines in older people with renal impairment - A cross-sectional register-based study in a large primary care population.
Schmidt-Mende K, Wettermark B, Andersen M, Elsevier M, Carrero JJ, Shemeikka T, et al
Basic Clin. Pharmacol. Toxicol. 2019 Mar;124(3):256-265

Incidence, Predictors, and Outcome Associations of Dyskalemia in Heart Failure With Preserved, Mid-Range, and Reduced Ejection Fraction.
Savarese G, Xu H, Trevisan M, Dahlström U, Rossignol P, Pitt B, et al
JACC Heart Fail 2019 01;7(1):65-76

Fractures and their sequelae in non-dialysis-dependent chronic kidney disease: the Stockholm CREAtinine measurements project.
Runesson B, Trevisan M, Iseri K, Qureshi AR, Lindholm B, Barany P, et al
Nephrol. Dial. Transplant. 2019 Jul;():

Causes of death across categories of estimated glomerular filtration rate: The Stockholm CREAtinine Measurements (SCREAM) project.
Runesson B, Qureshi AR, Xu H, Gasparini A, Lindholm B, Barany P, et al
PLoS ONE 2019 ;14(1):e0209440

Albuminuria as a Predictor of Cardiovascular Outcomes in Patients With Acute Myocardial Infarction.
Mok Y, Ballew SH, Sang Y, Grams ME, Coresh J, Evans M, et al
J Am Heart Assoc 2019 04;8(8):e010546

Incidence of, Associations With and Prognostic Impact of Worsening Renal Function in Heart Failure With Different Ejection Fraction Categories.
Löfman I, Szummer K, Evans M, Carrero JJ, Lund LH, Jernberg T
Am. J. Cardiol. 2019 11;124(10):1575-1583

Initiation of sodium polystyrene sulphonate and the risk of gastrointestinal adverse events in advanced chronic kidney disease: a nationwide study.
Laureati P, Xu Y, Trevisan M, Schalin L, Mariani I, Bellocco R, et al
Nephrol. Dial. Transplant. 2019 Aug;():

Estimated GFR and Hospital-Acquired Infections Following Major Surgery.
Ishigami J, Trevisan M, Xu H, Coresh J, Matsushita K, Carrero JJ
Am. J. Kidney Dis. 2019 01;73(1):11-20

Arteriovenous access placement and renal function decline.
Hahn Lundström U, Hedin U, Gasparini A, Caskey FJ, Carrero JJ, Evans M
Nephrol. Dial. Transplant. 2019 Oct;():

Plasma potassium ranges associated with mortality across stages of chronic kidney disease: the Stockholm CREAtinine Measurements (SCREAM) project.
Gasparini A, Evans M, Barany P, Xu H, Jernberg T, Ärnlöv J, et al
Nephrol. Dial. Transplant. 2019 09;34(9):1534-1541

Association of Acute Increases in Plasma Creatinine after Renin-Angiotensin Blockade with Subsequent Outcomes.
Fu EL, Trevisan M, Clase CM, Evans M, Lindholm B, Rotmans JI, et al
Clin J Am Soc Nephrol 2019 09;14(9):1336-1345

High-sensitivity C-reactive protein and the risk of chronic kidney disease progression or acute kidney injury in post-myocardial infarction patients.
Fu EL, Franko MA, Obergfell A, Dekker FW, Gabrielsen A, Jernberg T, et al
Am. Heart J. 2019 10;216():20-29

Potassium levels and risk of in-hospital arrhythmias and mortality in patients admitted with suspected acute coronary syndrome.
Faxén J, Xu H, Evans M, Jernberg T, Szummer K, Carrero JJ
Int. J. Cardiol. 2019 Jan;274():52-58

hsCRP Level and the Risk of Death or Recurrent Cardiovascular Events in Patients With Myocardial Infarction: a Healthcare-Based Study.
Carrero JJ, Andersson Franko M, Obergfell A, Gabrielsen A, Jernberg T
J Am Heart Assoc 2019 06;8(11):e012638

Dyskalemias and adverse events associated with discharge potassium in acute myocardial infarction.
Xu H, Faxén J, Szummer K, Trevisan M, Kovesdy CP, Jernberg T, et al
Am. Heart J. 2018 11;205():53-62

Incidence, predictors and clinical management of hyperkalaemia in new users of mineralocorticoid receptor antagonists.
Trevisan M, de Deco P, Xu H, Evans M, Lindholm B, Bellocco R, et al
Eur. J. Heart Fail. 2018 08;20(8):1217-1226

A real-world cohort study on the quality of potassium and creatinine monitoring during initiation of mineralocorticoid receptor antagonists in patients with heart failure.
Nilsson E, De Deco P, Trevisan M, Bellocco R, Lindholm B, Lund LH, et al
Eur Heart J Qual Care Clin Outcomes 2018 10;4(4):267-273

International Validation of the Thrombolysis in Myocardial Infarction (TIMI) Risk Score for Secondary Prevention in Post-MI Patients: A Collaborative Analysis of the Chronic Kidney Disease Prognosis Consortium and the Risk Validation Scientific Committee.
Mok Y, Ballew SH, Bash LD, Bhatt DL, Boden WE, Bonaca MP, et al
J Am Heart Assoc 2018 07;7(14):

Lower serum calcium is independently associated with CKD progression.
Janmaat CJ, van Diepen M, Gasparini A, Evans M, Qureshi AR, Ärnlöv J, et al
Sci Rep 2018 03;8(1):5148

A scheme based on ICD-10 diagnoses and drug prescriptions to stage chronic kidney disease severity in healthcare administrative records.
Friberg L, Gasparini A, Carrero JJ
Clin Kidney J 2018 Apr;11(2):254-258

Cinacalcet use and the risk of cardiovascular events, fractures and mortality in chronic kidney disease patients with secondary hyperparathyroidism.
Evans M, Methven S, Gasparini A, Barany P, Birnie K, MacNeill S, et al
Sci Rep 2018 02;8(1):2103

Incident Atrial Fibrillation and the Risk of Stroke in Adults with Chronic Kidney Disease: The Stockholm CREAtinine Measurements (SCREAM) Project.
Carrero JJ, Trevisan M, Sood MM, Bárány P, Xu H, Evans M, et al
Clin J Am Soc Nephrol 2018 09;13(9):1314-1320

eGFR and the Risk of Community-Acquired Infections.
Xu H, Gasparini A, Ishigami J, Mzayen K, Su G, Barany P, et al
Clin J Am Soc Nephrol 2017 Sep;12(9):1399-1408

Outcomes associated to serum phosphate levels in patients with suspected acute coronary syndrome.
Xu H, Evans M, Gasparini A, Szummer K, Spaak J, Ärnlöv J, et al
Int. J. Cardiol. 2017 Oct;245():20-26

Time in Therapeutic Range and Outcomes After Warfarin Initiation in Newly Diagnosed Atrial Fibrillation Patients With Renal Dysfunction.
Szummer K, Gasparini A, Eliasson S, Ärnlöv J, Qureshi AR, Bárány P, et al
J Am Heart Assoc 2017 Mar;6(3):

Incidence and determinants of hyperkalemia and hypokalemia in a large healthcare system.
Nilsson E, Gasparini A, Ärnlöv J, Xu H, Henriksson KM, Coresh J, et al
Int. J. Cardiol. 2017 Oct;245():277-284

Association Between Proton Pump Inhibitor Use and Risk of Progression of Chronic Kidney Disease.
Klatte DCF, Gasparini A, Xu H, de Deco P, Trevisan M, Johansson ALV, et al
Gastroenterology 2017 09;153(3):702-710

Long-term versus short-term dual antiplatelet therapy was similarly associated with a lower risk of death, stroke, or infarction in patients with acute coronary syndrome regardless of underlying kidney disease.
Carrero JJ, Varenhorst C, Jensevik K, Szummer K, Lagerqvist B, Evans M, et al
Kidney Int. 2017 01;91(1):216-226

Albuminuria changes are associated with subsequent risk of end-stage renal disease and mortality.
Carrero JJ, Grams ME, Sang Y, Ärnlöv J, Gasparini A, Matsushita K, et al
Kidney Int. 2017 01;91(1):244-251

Hyperkalemia After Initiating Renin-Angiotensin System Blockade: The Stockholm Creatinine Measurements (SCREAM) Project.
Bandak G, Sang Y, Gasparini A, Chang AR, Ballew SH, Evans M, et al
J Am Heart Assoc 2017 Jul;6(7):

The Stockholm CREAtinine Measurements (SCREAM) project: protocol overview and regional representativeness.
Runesson B, Gasparini A, Qureshi AR, Norin O, Evans M, Barany P, et al
Clin Kidney J 2016 Feb;9(1):119-27

Papers where the SCREAM project has collaborated with the CKD Prognosis Consortium

Relationship of Estimated GFR and Albuminuria to Concurrent Laboratory Abnormalities: An Individual Participant Data Meta-analysis in a Global Consortium.
Inker LA, Grams ME, Levey AS, Coresh J, Cirillo M, Collins JF, et al
Am. J. Kidney Dis. 2019 02;73(2):206-217

Evaluating Glomerular Filtration Rate Slope as a Surrogate End Point for ESKD in Clinical Trials: An Individual Participant Meta-Analysis of Observational Data.
Grams ME, Sang Y, Ballew SH, Matsushita K, Astor BC, Carrero JJ, et al
J. Am. Soc. Nephrol. 2019 Sep;30(9):1746-1755

Change in albuminuria and subsequent risk of end-stage kidney disease: an individual participant-level consortium meta-analysis of observational studies.
Coresh J, Heerspink HJL, Sang Y, Matsushita K, Arnlov J, Astor BC, et al
Lancet Diabetes Endocrinol 2019 02;7(2):115-127

Serum potassium and adverse outcomes across the range of kidney function: a CKD Prognosis Consortium meta-analysis.
Kovesdy CP, Matsushita K, Sang Y, Brunskill NJ, Carrero JJ, Chodick G, et al
Eur. Heart J. 2018 05;39(17):1535-1542

Predicting timing of clinical outcomes in patients with chronic kidney disease and severely decreased glomerular filtration rate.
Grams ME, Sang Y, Ballew SH, Carrero JJ, Djurdjev O, Heerspink HJL, et al
Kidney Int. 2018 06;93(6):1442-1451

Measures of chronic kidney disease and risk of incident peripheral artery disease: a collaborative meta-analysis of individual participant data.
Matsushita K, Ballew SH, Coresh J, Arima H, Ärnlöv J, Cirillo M, et al
Lancet Diabetes Endocrinol 2017 09;5(9):718-728

Additional papers

The SCREAM project fed data to the Global Burden of Disease Consortium and you can find the papers here.

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